Scarred heart pumps hope into patients' lives

A new, closed-chest surgery offers relief from the irregular heartbeat suffered by those with atrial fibrillation, and Largo is one of the few places it's done.

By SHANNON TAN
Published May 25, 2004

LARGO - Gordon Hanson couldn't talk on the phone without running out of breath. Once an active outdoor sportsman, he became so fatigued he had to take naps during the day.

Hanson, 65, suffered from atrial fibrillation - an irregular heartbeat that is a major cause of problems such as stroke and heart failure. He tried taking drugs and blood thinners, but they wreaked havoc with his liver and thyroid. He knew he had to find another solution.

A neighbor showed him an advertisement in the paper for a new procedure called MicroMaze, which allows doctors to surgically treat the condition without opening the chest. Ten weeks ago, Hanson underwent the surgery at Largo Medical Center.

Now, the Largo retiree no longer has to take medicine for his heart. He can bike for miles on the Pinellas Trail without tiring. He can hold a note while singing at three church services on Sunday.

"It gives hope to people," Hanson said.

Hanson is only the 65th person worldwide to undergo the microwave ablation surgery, which is performed at about four hospitals in the country, said Dr. Gary Dworkin, Hanson's surgeon.

With microwave ablation, a flexible microwave probe is used to burn small scars into the heart to disrupt the faulty electrical impulses that cause the irregular heartbeat.

Dworkin performed the surgery again Monday, this time on a 71-year-old man at Largo Medical Center. Dworkin and his partners at Cardiac Surgical Associates have operated on about 30 patients at Largo Medical and St. Joseph's Hospital in Tampa.

The operation is deemed a success if, after 12 weeks, the patient no longer has to take heart medications and has a regular heartbeat.

"It is certainly promising," said Dworkin, 46. "We are pleasantly surprised at what's come out of it post-op. The majority of people are off medication and doing well."

The procedure did not work with only two of the 30 patients, Dworkin said. Those patients had suffered from chronic atrial fibrillation for years, he said, and chose to undergo extensive open-heart surgery to be cured.

Dworkin estimates a 70 percent success rate for those not suffering from permanent atrial fibrillation.

Atrial fibrillation, which affects an estimated 2.2-million Americans, is a condition in which chaotic electrical impulses develop in the pulmonary veins and spread through the rest of the heart, creating an irregular heartbeat.

For some, the fluttering feeling in the chest comes and goes. Others suffer from persistent atrial fibrillation and need to control the condition with drugs and electrical shocks. The condition is considered permanent if a person's heartbeat is continuously irregular for at least six months.

A heart surgeon named Dr. James Cox developed the Cox-Maze III surgery for the problem in the 1980s. The surgery involves opening the chest, stopping the heart and making incisions in the heart to create a maze-like pathway disrupting the faulty impulses. It has a 90 percent success rate.

Then, Dr. Adam Saltman of the University of Massachusetts Medical Center in Worcester, Mass., used endoscopic TV cameras to allow for closed-chest surgery. Dworkin studied the microwave ablation surgery at Columbia University.

The procedure cannot be performed on people who have undergone open heart or lung surgery.

The patient is put under general anaesthesia. Dworkin makes three incisions on each side of the chest. Then he collapses the right lung to gain access to the beating heart. A whiplike microwave probe, which uses the same technology as a kitchen microwave, is inserted into the chest. Watching the screen, he snakes the catheter around the pulmonary veins.

The microwave radiation burns segments of the heart for 90 seconds at a time, creating scar tissue the diameter of a pencil. The scar tissue creates a barrier around the pulmonary veins to prevent the electrical impulses from spreading to the rest of the heart.

The patient can usually go home after three days. With the Cox-Maze III surgery, patients have to be hospitalized for an average of eight days, Dworkin said.

Dworkin emphasizes that it is too early to know what the long-term outcome of the surgery is. But patients such as Hanson no longer have to take medicines or undergo blood tests every month.

Hanson's mother and grandmother died after having strokes. He doesn't know if they suffered from atrial fibrillation, but he wasn't willing to take a chance.

Because the heart is beating chaotically in people with atrial fibrillation, the blood stagnates and clots. These clots can travel to the brain, causing a stroke.

For Hanson, who was diagnosed with atrial fibrillation two years ago, those worries are over.